The role of hydroxychloroquine (HCQ) in lowering the viral load of patients with COVID-19 is controversial. In our Institute, we treated more than 30,000 people with COVID-19 in 2020 and 2021, using the same diagnostic tools and the same treatment dosages. In this retrospective comparative study of data collected over this period, we aimed to compare the viral clearance in the nasopharynx as determined by qPCR in patients who were treated with HCQ and those who were not. As a new feature, we adjusted the data according to the most significant confounding factors (age, initial viral load, and timescale between the onset of symptoms and treatment). Of the 1 276 patients selected from our database, 776 were treated with HCQ and 500 were not. Viral clearance in the treatment group was reached significantly earlier than in the non-treatment group, at days 5, 10 and 30. These differences remain significant after adjustments for confounding factors. In conclusion, although age, initial viral load, and time to treatment do influence the viral load in patients with COVID-19, hydroxychloroquine associated with azithromycin still independently significantly lowered viral load more rapidly than other treatments, including azithromycin alone.

Background and Purpose: The Bazhen decoction is one of the most extensively used Traditional Chinese medicine (TCM) prescriptions for anti-aging. However, due to the complicity of the components, the pharmacological mechanism of Bazhen decoction is still limited. Experimental approach: We applied RNA sequencing and transcriptome analysis to get the full view of the signaling pathways regulated by Bazhen decoction in the wild type cell background. By using the progeroid cells derived from Werner syndrome mice, we applied Western blot, Immunofluorescence, flow cytometry and telomere FISH to verify the transcriptome data. Key Results: The transcriptome profile revealed that Bazhen decoction might systematically regulate multiple anti-aging pathways, including stem cell regulation, protein homeostasis, cardiovascular function, neuronal function, anti-inflammation, anti-DNA damage induced stress, DNA helicase activity and telomere lengthening. We found that multiple DNA helicases and telomere regulating proteins were up-regulated by Bazhen decoction, which promoted the resolving of G-quadruplex (G4) structure, and facilitated DNA replication and telomere elongation. These improvements also endowed the cellular resistance to DNA damages induced by replication stress. Together these data suggest that Bazhen decoction facilitate G4 resolving and telomere maintenance, which might contribute to the longevity sustaining properties revealed by transcriptome profile. Conclusions & Implications: Our data revealed a new strategy for recovering the pharmacological signature pathways for TCM, which could help the clinical precision medicine of TCM. By applying transcriptome in TCM-treated normal cell, we tried out a systematic analysis for dissecting the molecular mechanism of complicated TCM prescription in the normal genetic background.

Background: To investigate the distribution of bacterial pathogens of lower respiratory tract infection (LRTI) in hospitalized elderly patients during the COVID-19 epidemic and to explore the influence of COVID-19 on the distribution of bacterial pathogens, in order to provide guidance for clinical diagnosis. Methods: Specimens of sputum from elderly LRTIs patients at Fuding Hospital of China were collected from October 2022 to January 2023. Cultures and identification were done, and RT-PCR was employed to detect SARS-Cov-2 nucleic acid. Results: A total of 195 isolates were characterized in 163 sputum samples of consecutive hospitalized elderly patients, of which 11.3% were Gram-positive bacteria and 88.7% Gram-negative. The top of frequently isolated pathogens were Klebsiella pneumonia (30.3%), Pseudomonas aeruginosa (19.0%), Acinetobacter baumannii (12.8%), Stenotrophomonas maltophili, (7.7%), Escherichia coli (7.2%). According to the results of novel coronavirus nucleic acid detection, the 163 patients were divided into COVID-19 group and non-COVID control (CNT) group. The comparison of bacterial distribution between the groups revealed that Stenotrophomonas maltophilia was lower in the COVID-19 than in the CNT group, while Acinetobacter baumannii was higher in the COVID-19 group, and the difference was statistically significant (P < 0.05). Conclusion: The major bacteria identified in sputum culture of hospitalized elderly patients were Klebsiella pneumonia, Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and Escherichia coli. Furthermore, the distribution of Stenotrophomonas maltophilia and Acinetobacter baumannii between the COVID-19 and CNT groups was found to be significantly different (P< 0.05), while there were no significant differences in the distribution of other bacteria.

Background: People with cystic fibrosis (PwCF) have chronic lung disease and may be at increased risk of COVID-19-related morbidity and mortality. This study aimed to determine seroprevalence and clinical characteristics of SARS-CoV-2 infection in children with CF, and to assess antibody responses following SARS-CoV-2 infection or vaccination. Methods: Children and adolescents with CF followed at Seattle Children’s Hospital were enrolled between July 20, 2020 and February 28, 2021. SARS-CoV-2 serostatus was determined on enrollment, at 6 and 11 months (+/-2 months) for nucleocapsid and spike IgG. Participants completed intake and weekly surveys inquiring about SARS-CoV-2 exposures, viral/respiratory illnesses, and symptoms. Results: Of 125 PwCF enrolled, 14 (11%) had positive SARS-CoV-2 antibodies consistent with recent or past infection. Seropositive participants were more likely to identify as Hispanic (29% vs 8%, p=0.04) and have pulmonary exacerbations requiring oral antibiotics in the year prior (71% vs 41%, p = 0.04). Five seropositive individuals (35.7%) were asymptomatic, while six (42.9%) reported mild symptoms, primarily cough and nasal congestion. Anti-spike protein IgG levels were approximately 10-fold higher in participants following vaccination compared with participants who had natural infection alone (p < 0.0001) and resembled levels previously reported in the general population. Conclusions: A majority of PwCF have mild or no symptoms of SARS-CoV-2 making it difficult to distinguish from baseline respiratory symptoms. Hispanic PwCF may be disproportionately impacted, consistent with racial and ethnic COVID-19 disparities among the general US population. Vaccination in PwCF generated antibody responses similar to those previously reported in the general population.

During the Covid-19 pandemic, the morbidity of anorexia increased both in its scope and in its severity. Research conducted thus far, has raised questions regarding the unique influences that the pandemic imposed on individuals with anorexia and those at risk for developing it. This opinion article offers a psychoanalytic understanding for the increased morbidity of anorexia following the outbreak of COVID-19. It argues that the encounter between an external reality saturated with restrictions and prohibitions and the anorexic internal reality intensified the anorexic symptomology. The authors present explanations regarding the ways in which the pandemic undermined the anorexic defenses and contributed to the increase of anorexia. They conclude that COVID-19 has led to the exacerbation of anorexia through employment of two key defense mechanisms of anorexia, which are: 1. Implementation of prohibitions, reductions, and restrictions. 2. Having an omnipotent sense of self, in which the body is regarded as controllable.

Widespread school closures and other non-pharmaceutical interventions (NPIs), used to limit the spread of SARS-CoV-2, significantly disrupted transmission patterns of seasonal respiratory viruses. As NPIs were relaxed, populations were vulnerable to resurgence. This study within a small community assessed acute respiratory illness among kindergarten through grade 12 students as they returned to public schools from September through December 2022 without masking and distancing requirements. The 277 specimens collected demonstrated a shift from rhinovirus to influenza. With continued circulation of SARS-CoV-2 and return of seasonal respiratory viruses, understanding evolving transmission patterns will play an important role in reducing disease burden.

Clinical Validity and Conceptual Interpretation of Impact of alcohol consumption on COVID-19 severityRama Jayaraj 1*, Sameep Shetty 2, A Devi3, Suja S4, Yash Merchant5

This study explores the development and testing of a social resilience psychometric scale, through physical and social unrest during the COVID-19 pandemic. Qualitative interviews (N = 40) were aggregated to define social resilience measured statements. When tested in quantitative analysis respondents (N = 901) “see myself as a monster” when evaluating others and are “scared to let people know the real me” fearing loss of relationships. Anxiety is heightened through a perception through the measure “could have done better.” When testing for “want to be liked even when disagree on issues” Black respondents are significantly different than White, Asian and those expressing other races. Liberals and moderate conservatives are significantly different in perception of social resilience, as are those exemplifying feminine versus masculine traits. Logistic regression testing for “comfortable with who I am in society” indicates narcissism (65% more likely) and negative social resilience (56% more likely) are key adapters. Human wellbeing, the act of perceiving self as a healthy or unhealthy actor in society, has been influenced through groupthink and polarization of the “other.” This study suggests the construct of self-esteem has been pushed into reactive mode. Research that explicates the psychological dimensions of modern resilience, is warranted.

Objectives: To evaluate cellular immune responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines immunization in population based on HLA-E-restricted CD8 + T cell epitopes identification. Methods: HLA-E-restricted SARS-CoV-2 CD8 + T cell nonamer peptides were predicted with software. HLA-E-transfected K562 cells binding assay was used to screen for high-affinity peptides. IFN-γ enzyme-linked immunospot assay were used to identify HLA-E-restricted epitopes. HLA-E/epitope tetramer was employed to detect the frequencies of epitope-specific CD8 + T cells. Results: Four CD8 + T cell epitopes on spike protein of SARS-CoV-2 restricted by both HLA-E*0101 and E*0103 were identified. HLA-E-restricted epitope specific IFN-γ-secreting CD8 + T cell responses could be detected in individuals vaccinated with SARS-CoV-2 vaccines. Importantly, the frequencies of epitope-specific CD8 + T cell in Ad5-nCoV vaccinated individual were higher than that in individuals vaccinated with recombinant protein or inactivated vaccines. Moreover, frequencies of epitope-specific CD8 + T cells could maintain for at least 120 days after only one dose Ad5-nCoV vaccination. While frequencies of epitope-specific CD8 + T cells decreased in individuals after two doses of Ad5-nCoV vaccination. Conclusions: These findings may contribute to more comprehensive evaluating protective effects of vaccines for SARS-CoV-2, meanwhile may provide information to characterize HLA-E-restricted CD8 + T cell immunity against SARS-CoV-2 infection.

Background: No study has directly compared the efficacy of nirmatrelvir-ritonavir and azvudine for treatment. The efficacy of these two drugs at high altitudes was compared. Materials and Methods: This was a retrospective cohort research on hospitalized patients with COVID-19 who were treated with nirmatrelvir-ritonavir or azvudine in Tibet between August 1 and September 30, 2022. Results: The electronic health data of 731 patients were retrospectively reviewed. Nirmatrelvir-ritonavir and azvudine groups enrolled 338 and 147 patients, respectively. Among patients with mild, common, and severe (including critical) COVID-19, there was no difference in the median duration of hospitalization between treatment with nirmatrelvir-ritonavir and that with azvudine: 8 (5–10.25) vs. 9 (5–13) (P=0.096); 8 (5–11) vs. 8 (5–13) (P=0.227); and 13 (7–17.75) vs. 10 (7.5–17.5) (P=0.994) days, respectively. Moreover, patients in the nirmatrelvir-ritonavir group had a shorter median time for nuclear acid negative conversions (NANC) than those in azvudine group: 6 (4–9) vs. 10 (6.25–13.75) (P=0.000), 8 (5–12) vs. 10.5 (7–14) (P=0.013), and 7 (5.25–12.75) vs. 15 (7.5–23.5) (p=0.023) days, respectively. Conclusion: Azvudine yielded a longer time for NANC and an equivalent duration of hospitalization and may have comparable efficacy with nirmatrelvir-ritonavir, making it a viable treatment option for COVID-19.

Over 645 million people worldwide have been infected with SARS-CoV-2, the virus that causes COVID-19. Critical knowledge gaps regarding the characteristics, duration, and impact of symptoms due to “long COVID”. This study evaluated the persistence of symptoms at one year following hospitalization with COVID-19, comparing responses on standardized measurement tools to population norms. Adults hospitalized with COVID-19 March-October 2020 during the initial emergence period in Southeast Michigan were eligible. A detailed survey was conducted via telephone 9-15 months after hospital discharge. Questions assessed fatigue, dyspnea, and physical functioning related to their COVID-19 illness. The median World Health Organization Disability Assessment Schedule (WHODAS) polytomous score placed 50% (n=20/40) of participants in the 90 th percentile of disability based on population norms. The mean SF-36 physical functioning score was almost nine points below population norms (mean=70.6, standard deviation=27.4). Additionally, 47.5% of individuals (n=19) were severely emotionally affected by their health condition. Over half of participants surveyed were still impacted a year after initial infection, experiencing limited functional ability, fatigue, and emotional difficulties. Given the impact of these symptoms on day-to-day quality of life, further studies are needed to develop strategies for treatment and management of post-COVID conditions.

Objective: To explore the effects of antenatal anxiety on fetal growth, and to investigate the effect of anxiety timing and the potentially different effect of trait anxiety and state anxiety on fetal growth. Design: Observational cohort study. Setting: Barcelona, Spain. Population: A cohort of 204 women with singleton pregnancies attending the antenatal clinic of a tertiary care setting during the strict lockdown of the COVID-19 pandemic in 2020. Methods: Psychosocial factors, maternal demographics, and obstetric outcomes were studied as potential predictors of low birth weight. The State-Trait Anxiety Inventory (STAIs, STAIt), the Edinburgh postpartum Depression Scale (EPDS) and the Medical Outcomes Study Social Support Survey (MOS-SSS) were used to assess symptoms of anxiety, symptoms of depression, and social support, respectively. Main Outcome Measures: Neonatal birth weight, head circumference and length. Results: There was a negative correlation between STAIt score (trait anxiety) and birth weight percentile (r=-0.228, p=0.047). In the univariate linear regression analysis, a lower maternal weight and BMI before pregnancy, parity, increased STAIt score and preterm birth below 37 weeks of gestation (p=0.008, p=0.015, p=0.028, p=0.047 and p=0.022, respectively) were identified as predictive risk factors for low birth weight. In the multivariate lineal regression analysis only a lower maternal weight before pregnancy and an increased STAIt score were independent predictors for low birth weight (p=0.020, p=0.049, respectively). Conclusions: Anxiety during pregnancy impacts birth weight, and specifically the trait anxiety, the one associated with the personality attributes, is a predictor for low birth weight.

Title pageTitle: Rust-colored patches of the lower extremity in a COVID-19 patientAuthrors: Jacem Rouatbi1, Mouna Korbi1*, Nouha Ben Abdeljalil2, Hichem Belhadjali1*, Jameleddine Zili1*

A Case of TAFRO syndrome after COVID-19 vaccinationHitomi Hirosea, Hitoshi Suzukia,c*, Yukako Umezawaa, Masako Iwasakia, Hiromitsu Fukudaa, Hisatsugu Takaharaa, Shigeki Tomitab, Yusuke Suzukica. Department of Nephrology, b. Department of Pathology, Juntendo University Urayasu Hospital, Chiba, Japan. c. Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.Correspondence to:Hitoshi Suzuki, M.D., Ph.DDepartment of Nephrology, Juntendo University Urayasu Hospital2-1-1 Tomioka, Urayasu-shi, Chiba 279-0021, JapanEmail: shitoshi@juntendo.ac.jpKey words: COVID-19, mRNA vaccine, TAFRO syndrome, renal dysfunction

Background: Chronic rhinosinusitis (CRS) is a heterogeneous disease characterized by persistent sinonasal inflammation and sinus microbiome dysbiosis. Nasal polyps (NPs) is one of the main manifestations which cause diverse clinical symptoms of CRS. We conducted a bibliometric and visual analysis of CRS and NPs articles published between 2003 and 2022 to provide researchers with the current state of research and potential directions. Method: We used a systematic search strategy to search relevant articles in the databases of the Web of Science from 2003 to 2022. VOSviewers, Bibliometrix R package, and CiteSpace were used to perform the bibliometric analysis. Results: 3,907 publications, including 3,266 “articles” and 641 “reviews” were retrieved. The USA made the highest contributions to global research, followed by China; furthermore, Northwestern University, Capital Medical University, and Sun Yat-Sen University had the highest number of publications. A total of 12,894 authors participated in this research, with the most published author being Bachert C., followed by Schleimer Robert P. and Schlosser Rodney J.. And the authors with the most co-citations were Bachert C., Fokkens W.J., and Gevaert P. 428 journals had published the articles of this research. Moreover, the journal with the most publications was the International Forum Of Allergy & Rhinology and the Journal Of Allergy And Clinical Immunology received the most citations. “Covid-19”, “biologic”, and “type 2 inflammation” were the top current research hotspots. Conclusion: The United States and Northwestern University were the leading country and institution in researching CRS and NPs. And Bachert C. is the most influential expert. The International Forum Of Allergy & Rhinology published the most articles, and the Journal Of Allergy And Clinical Immunology got the highest number of citations. Moreover, “Covid-19”, “biologic”, and “type 2 inflammation” were the trending topics.

[Abstract] Objective: To develop a pneumonia risk prediction model for SARS-CoV-2 infected patients to reduce unnecessary chest CT scans; Materials and Methods: Retrospective analysis was performed on the clinical data of SARS-CoV-2-positive patients who visited outpatient and emergency clinics and underwent chest CT scans at the Mawangdui Branch of Hunan Provincial People’s Hospital from 20 December 2022 to 23 December 2022 and at the Tianxinge Branch of Hunan Provincial People’s Hospital from 1 January 2023 to 4 January 2023. A retrospective analysis of imaging and clinical data from 205 cases (training cohort) and 94 cases (validation cohort) of SARS-CoV-2-positive patients who visited outpatient and emergency clinics was conducted. The predictor variables were screened using the “univariate and then multivariate logistic regression” and “least absolute shrinkage and selection operator (LASSO)” approaches, and the predictive model was constructed using multifactorial logistic regression and represented as a nomogram. The diagnostic effectiveness of the pneumonia risk model was evaluated using receiver operating characteristic (ROC) curves; the Delong test and Integrated Discrimination Improvement Index (IDI) were used to compare the AUC of the pneumonia risk model with the AUCs for predictors incorporated in the model alone. The calibration of the pneumonia risk model was assessed using calibration curves; Decision curve analysis (DCA) was used to evaluate the clinical validity of the pneumonia risk model. In addition, a smoothed curve was fitted using a generalized additive model (GAM) to explore the relationship between the pneumonia grade and the model’s predicted probability of pneumonia; Results: “univariate and then multivariate logistic regression ” and Lasso regression together show that age, natural log-transformed value (InCRP), Monocytes percentage (%Mon) are valid predictors of pneumonia risk; the AUC of the pneumonia risk model was 0.7820 (95% CI: 0.7254-0.8439) in the training cohort and 0.8432 (95% CI: 0.7588-0.9151) in the validation cohort; at the cut-off value of 0.5, the sensitivity and specificity of the pneumonia risk model were 70.75%, 66.33% (training cohort), 76.09%, and 73.91% (validation cohort), the calibration curves showed that the pneumonia risk model has good calibration accuracy. The decision curve analysis showed that the pneumonia risk model has high clinical value in predicting the probability of pneumonia in SARS-CoV-2 infected patients. Conclusion: The pneumonia risk prediction model developed in this study can be used to predict the risk of pneumonia in SARS-CoV-2 infected patients diagnostically.

A major tool for curtailing the spread of COVID-19 pandemic in China was a nationwide lockdown, which led to significant reductions in anthropogenic emissions and fine particulate matter (PM2.5). However, the lockdown measures did not prevent high PM2.5 pollution episodes (EPs). Three severe EPs were identified in the Beijing-Tianjin-Hebei (BTH) region during the lockdown. The integrated process rate (IPR) analysis tool in the Community Multiscale Air Quality (CMAQ) model was employed to quantify the contributions of individual atmospheric processes to PM2.5 formation during the lockdown in the BTH region. The IPR results showed that emissions and aerosol processes were the dominant sources of net surface PM2.5 in Beijing and Tianjin, constituting a total of 86.2% and 92.9%, respectively, while emissions, horizontal transport, and aerosol processes dominated the net surface PM2.5 in Shijiazhuang and Baoding. In addition, the EPs in Beijing and Tianjin were primarily driven by local emissions, while the EPs in Shijiazhuang and Baoding were attributed to combined local emissions and regional transport. The reductions in PM2.5 in Case 2 relative to Case 1 were attributed to the weaker PM2.5 formation from emissions and aerosol processes. However, the EPs were enhanced by low planetary boundary layer heights, low vertical export of PM2.5 from the boundary layer to the free troposphere, and substantial horizontal import, especially in Shijiazhuang and Baoding. This study improves the understanding of buildup of PM2.5 during the EPs, and the results provide insights for designing more effective emissions control strategies to mitigate future PM2.5 episodes.

Abstract Introduction Telehealth and remote monitoring of patients of patients with mild COVID-19 infection have developed rapidly in response to the pandemic. Many healthcare systems have embraced telehealth for remote clinical monitoring and pulse oximetry for enhanced monitoring. Methods The experience of a large healthcare centre’s COVID Virtual Ward was reviewed retrospectively with a particular focus on evaluating the effectiveness, safety and utility of finger pulse oximetry within the home. Data from a 2 month period in early 2022 during a BA1 Omicron wave was retrospectively reviewed. 551 high risk patients were issued with pulse oximeters for monitoring oxygen saturations within their home. All patients received daily clinical review via telephone by a nurse or doctor. The group was highly vaccinated with only 6.4% of the cohort unvaccinated. Oximeters were promptly delivered via a courier service across a vast geographical area. Results Pulse oximetry was well utilised by most patients. Only 2.7% of the cohort demonstrated resting oxygen saturations of <94% during their Virtual Ward admission. Most patients reporting dyspnoea were able to be safely managed without escalation to an emergency department due to reassuring clinical and oximetry assessment. Home oxygen saturations correlated well with saturations recorded within the ED, with no patients found to have lower saturations compared with home saturations. Discussion Within a high risk population experiencing COVID-19 infection, pulse oximetry was a useful tool in clinical assessment and allowed a substantial reduction in COVID-19 related ED presentations.

A document by Ke-Wei Zhu. Click on the document to view its contents.

Objectives: COVID-19 has been the primary health problem and because of the virus affinity to endothelial cells, it has become an important reason of vascular problems and cardiac injury. After mild COVID-19 infection, patients frequently attend to the cardiology clinics with cardiac symptoms and their primary cardiac tests are mostly normal. The aim of the study is analysing if the difference of cardiac deterioration could be shown with 2D-speckle tracking echocardiography between symptomatic and asymptomatic patients when transthoracic echocardiography parameters are normal. Methods: In this retrospective single centre study, total of 2741 transthoracic echocardiography records were assessed and post-COVID patients (n:108) were detected and divided into ‘symptomatic’ and asymptomatic’ patient groups and left ventricular global longitudinal strain values were compared. Results: The number of patients with normal global longitudinal strain values were equal in the groups and the number of patients with impaired GLS values in the symptomatic group were more than the asymptomatic group (15 patients in the symptomatic group and 4 patients in the asymptomatic group) and the difference was statistically different (p=0,008). The average GLS values were -18,88±2,50 in the asymptomatic group and -17,40±3,68 in symptomatic group but the difference was not statistically significant (p=0,098) Conclusion: More symptomatic patients than the asymptomatic ones have impaired left ventricular GLS values according to the results of this study. Even if it is not statistically significant, the mean left ventricular GLS values are also reduced in symptomatic patients after mild COVID-19 infection.

In this paper, we propose a blockchain-based cold chain technology for vaccine cooling track. The COVID-19 pandemic has caused the death of millions of people. An important step towards ending the pandemic is vaccination. Vaccines must be kept under control temperature during the whole process, from fabrication to the hands of the health professionals who will immunize the population. However, there are numerous reports of vaccine loss due to temperature variations, and, currently, people getting vaccinated have no control if their vaccine was kept safe. Blockchain is a technology solution that can provide public and verifiable records. We review the World Health Organization (WHO) cool chain and Blockchain technology. Moreover, we describe current IoT temperature monitoring devices and propose Blockcoldchain to track vaccine cold chain using blockchain, thus proving an unalterable vaccine temperature history. Our experimental results using smart contracts demonstrate the system’s feasibility.

Background COVID-19 vaccination program for adults in India is one of the highly successful vaccination drives globally but acceptance of COVID-19 for children and adolescents is largely unknown. As parents are primary decision-makers for their children, we aimed to assess parents’ perceptions and intentions regarding COVID-19 vaccination for children in India. Aim To assess parental perceptions and intention to get COVID-19 vaccination for their children (aged<18 years), Materials and Methods A cross-sectional anonymous web-based survey was designed. Healthcare workers of a tertiary care institute of Eastern U.P., India having any children aged <18 years were the study population. They were recruited through snowball sampling and were sent the study questionnaire in Google form through email and WhatsApp. Bi-variate analysis was performed to find out the predictors of child vaccination willingness among the parents. Results A total of 388 healthcare workers parents (HCWPs) having a child < 18 years of age completed the survey. Mean age of the parents were 40.28 ±11.34 years. Majority (96.9%) received recommended 2 doses of COVIID-19 vaccine. Around 91% of the parents agreed that COVID-19 vaccines are important for child’s health whereas 89% agreed that COVID-19 vaccines are effective. A total 356 (91.7%) participants shown willing to vaccinate their child with COVID-19 vaccine, 91.3% of them intended to do so as soon as possible Factors found to be significantly associated with the stated willingness for child COVID-19 vaccination among the participants were younger age, female gender, urban residence, absence of any chronic illness, lower monthly income, history of COVID-19 in child and the child immunized with all routine childhood vaccines. Parental concerns mainly centered around vaccine need and its safety. Conclusion The healthcare worker parents (HCWPs) have positive attitude and low vaccine hesitancy towards COVID-19 vaccination for children with around 92% of them currently willing to vaccinate their children with COVID-19 vaccine. Further longitudinal studies are required to be conducted to assess the trend of parental acceptance of COVID vaccine.

Numerous different complications have been reported following Covid-19 disease.Although the disease often improves after going through various clinical phases,some people have Various complications, including coagulation disorders. The patient is a 59-year-old man who developed extensive heart thrombosis following covid19 involvement a month ago and was hospitalized with extensive cardiac dysrhythmias

New-onset pemphigus after COVID-19Yihang Xie1 Mei Yang1 Peimei Zhou1* Jiaming Fan1 Sijie Zhou11.Department of Dermatovenereology, Chengdu Second People’s Hospital, Chengdu, China* Corresponding Author: 46551704@qq.comrunning head: pemphigus after COVID‐19The category of the article: LetterKeywords: COVID‐19, pemphigusManuscript word count: 690 wordsThe number of figures: 2The number of tables: 0The number of references: 8Correspondence to: Peimei Zhou, M.D, Ph.D., Department of Dermatovenereology, Chengdu Second People’s Hospital, Qingyun Street, Chengdu, 610041, China.Tel: +86 18908176315; E-mail:46551704@qq.comFull conflict of interest statement: Y. Xie, and my co-authors have no conflict of interest to declare.Ethics statement: The patient has consented to publish this information.Data availability statement: Data sharing does not apply to this article as no new data were created or analyzed in this study.Funding sources: noneDear Editor,Cutaneous manifestations of coronavirus disease (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; family Coronaviridae, genus Betacoronavirus, subgenusSarbecovirus ), have been increasingly reported. SARS-CoV-2 infection is multisystemic and leads to potentially detrimental effects on various organs. Maculopapular, urticarial, vesicular, livedoid, and Chilblain-like lesions (CBLL) have been commonly reported to be associated with COVID-191. Here, we encountered an intriguing case of pemphigus that developed after COVID-19 infection.A 73-year-old male presented with a 42-day history of pruritic flaccid blisters that arose on the trunk and both upper limbs on normal and erythematous skin. Cutaneous lesions started 3 days after the positive reverse transcription polymerase chain reaction (RT-PCR) test diagnostic for SARS-CoV-2. He denied any history of systemic diseases, medication, and medicine or food allergies, and had not used any medication before symptom onset. The patient had first been diagnosed with allergic dermatitis caused by COVID-19 at another hospital and was prescribed oral prednisone (8 mg once daily for 4 days). The patient reported no new blisters, but the erythema did not fade; therefore, he visited our hospital. Physical examination revealed cutaneous lesions on the trunk and both upper limbs without mucosal involvement and scattered superficial blisters that developed into crusted erosions on an erythematous base(Figure1 A-D). Laboratory examination revealed normal white cell count (8.63 Ö109/L; normal 3.5-9.5 Ö109/L) with eosinophilia (6%; normal 0.5%-5.0%). Desmoglein (Dsg) 1 antibody levels were > 150 U/mL (positive: > 20), while Dsg3, BP(bullous pemphigoid)180, and BP230 antibody levels were within normal ranges. Other laboratory tests including RT-PCR targeting SARS-CoV-2, immunoglobulin, erythrocyte sedimentation rate, the spectrum of antinuclear antibodies, and T-spot were negative or normal. Chest and abdominal computed tomography revealed chronic inflammatory changes but no obvious tumors. Histological analysis of an incisional cutaneous biopsy taken from the patient’s abdomen showed subcorneal blister formation, acantholytic cells within the blister, and marked spongiotic edema in the spongiosa layer that had mixed inflammatory infiltrate with eosinophils, leukomonocytes, and neutrophils(Figure2A). Direct immunofluorescence (DIF) showed deposition of intracellular IgG and C3 in subepidermal 2/3 interspinous cells, though was negative for IgA and IgM, confirming pemphigus(Figure2B,C). Considering the good response to hormone treatment, the patient continued oral prednisone at 8 mg once daily along with the use of topical corticosteroids. Symptoms were completely absent after 3 weeks(Figure1 E-F).An increasing number of studies on cutaneous manifestations of COVID-19 have been reported; however, knowledge is still lacking on the common skin manifestations of this disease. Nonspecific cutaneous manifestations due to SARS-CoV-2 infection have also been reported, such as immune thrombocytopenic purpura (ITP), dengue-like exanthem, pityriasis rosea-like eruptions, acral ischemia, mucositis, dusky lesions, and bullae2.3.4. We searched all relevant articles and found only two cases of pemphigus vulgaris induced by COVID-19. In the case presented here, we realized that COVID-19 may be responsible for the rash eruption, possibly due to an inflammatory reaction5. The onset time of the rash was similar to that in the cases of pemphigus previously reported by De Medeiros5 and Mohaghegh F6 (within 1.5 months). In our case, although direct immunofluorescence showed subepidermal 2/3 deposition, we still diagnosed pemphigus foliaceus in combination with the pathological presentation, indirect immunofluorescence, and good treatment outcome. We speculate that the reason why direct immunofluorescence showed subepidermal 2/3 deposition may be the marked sponge edema of the epidermis, which may lead to a discontinuity of acantholysis, resulting in leakage of Dsg1 into the deeper epidermis.Pemphigus is defined as a group of rare mucocutaneous autoimmune diseases. Its etiology is unknown, though there are studies on autoimmune etiology which is believed to be related to stimulation by certain drugs, ultraviolet radiation, and malignant tumors; these induce autoimmune reactions by making the adhesive substances between the spiny cell layers become autoantigens7. It is rarely considered, however, that viral infections might cause pemphigus. The ability of SARS-CoV-2 to induce a hyper-stimulated immune state was discovered at the beginning of the pandemic8. As an instrumental trigger of autoimmunity, SARS-CoV-2 infection could be a trigger for autoimmune reactions, possibly through more than one mechanism. Because of this, all factors should be considered in any patient presenting with new-onset or exacerbating cutaneous reactions.